1. Asthma Lynn Helliwell

2. Key Facts More than five million people in the UK are being treated for asthma More than five million people in the UK are being treated for asthma Many emergency admissions are believed to be avoidable Many emergency admissions are believed to be avoidable Many people who die from asthma had well recognised identifiable risk factors Many people who die from asthma had well recognised identifiable risk factors Up to 200,000 people in the North West have undiagnosed asthma Up to 200,000 people in the North West have undiagnosed asthma

3. Key facts Asthma costs the NHS £1 billion a year with 75% of the admissions being avoidable saving a possible £44 million Asthma costs the NHS £1 billion a year with 75% of the admissions being avoidable saving a possible £44 million Asthma can cause disability and 3 people per day die of it Asthma can cause disability and 3 people per day die of it Asthma cannot be cured but can be managed Asthma cannot be cured but can be managed Upto 5.4 million people in the uk suffer from asthma Upto 5.4 million people in the uk suffer from asthma

4. Asthma is a condition that causes the airways in your lungs to narrow intermittently. Asthma is a condition that causes the airways in your lungs to narrow intermittently. This airway narrowing, which makes breathing difficult by reducing the amount of air that can travel in and out of the lungs, is due to: This airway narrowing, which makes breathing difficult by reducing the amount of air that can travel in and out of the lungs, is due to: –inflammation and swelling of the airways; –excessive production of thick mucus in the airways; and –tightening of the bands of smooth muscle around the airways this is called bronchoconstriction

7. How do we diagnose? History History Symptoms Symptoms Reversibility testing Reversibility testing

8. History History –:Personal/family history of asthma, respiratory disease – Atopy (eczema/hay fever ) –Occupation Symptoms: Wheeze, Cough, SOB Symptoms: Wheeze, Cough, SOB –worse at night or early morning –after taking aspirin or beta blockers

9. Triggers respiratory infections; respiratory infections; allergens (substances that cause allergies) — for example, pollens, dust mites, mould; allergens (substances that cause allergies) — for example, pollens, dust mites, mould; cigarette smoke; cigarette smoke; vigorous exercise; vigorous exercise; certain medications, such as aspirin, beta- blockers and non-steroidal anti-inflammatory drugs (NSAIDs); certain medications, such as aspirin, beta- blockers and non-steroidal anti-inflammatory drugs (NSAIDs); anxiety or stress; Emotion anxiety or stress; Emotion cold air. cold air. Aerosols Aerosols

10. Reversibility testing Spirometry Spirometry Peak flow Peak flow Medication Medication

11. Clinical features differentiating COPD and asthma COPDAsthma Smoker or ex-smoker Nearly all Possibly Symptoms under age 35 RareOften Chronic productive cough CommonUncommon Breathlessness Persistent and progressive Variable Night time waking with breathlessness and or wheeze UncommonCommon Significant diurnal or day to day variability of symptoms UncommonCommon

12. HIGH PROBABILITY diagnosis of asthma Likely INTERMEDIATE PROBABILITY diagnosis uncertain or poor response to asthma treatment LOW PROBABILITY other diagnosis likely

13. Aim To control the disease. Aim To control the disease. Control is defined as: No daytime symptoms, No night time awakening due to asthma No need for rescue medication No exacerbations No limitations on activity including exercise Normal lung function (in practical terms FEV1 and/or PEF>80% predicted or best) with minimal side effects. BTS/SIGN 2011

14. Case history: John 46yrs Non smoker night time wheeze and cough Increasing sob Mother had respiratory problems, not sure what they were Eczema as a child Some days worse than others, today not too bad Spirometry normal

15. Case history Joan 46yrs Smokes 30 – 40 daily Daily symptoms of wheezing, coughing sob (can hear and see these whilst with patient) BMI 40 Difficult to get accurate history as mental health problems Spirometry all readings were above 90% predicted

16. Case history Joseph 54 Smokes 20 daily – 35 pack years Persistent cough worse at night No sob, no wheeze No fh of respiratory disease No recent bad chest Painter and decorator Spirometry normal Chest x ray normal

17. Case history

18. COMBINATION THERAPIES NOW AVAIABLE: FLUTIFORM FLUTIFORM FOSTAIR FOSTAIR RELVAR ELLIPTA RELVAR ELLIPTA SERETIDE SERETIDE SYMBICORT SYMBICORT

19. Stepwise approach 1. Start treatment at step most appropiate to severity 2. Achieve early control 3. Maintain control by: Stepping up treatment as necessaryStepping up treatment as necessary Stepping down when control is goodStepping down when control is good 4. Follow BTS/Sign management for asthma guidelines http://www.sign.ac.uk/guidelines/fulltext/63/in dex.html http://www.sign.ac.uk/guidelines/fulltext/63/in dex.html http://www.sign.ac.uk/guidelines/fulltext/63/in dex.html